What are the ESMO guidelines on first-line treatment for primary mediastinal B-cell lymphoma (PMBCL)?

Updated: Sep 14, 2019
  • Author: Sonali M Smith, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

ESMO guidelines recommend rituximab in combination with any of the following regimens [36] :

  • CHOP: cyclophosphamide, doxorubicin, vincristine, and prednisone
  • VACOP-B: etoposide, doxorubicin, cyclophosphamide, vincristine, prednisolone and bleomycin;
  • MACOP-B: methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisolone and bleomycin
  • DA-EPOCH: dose-adjusted etoposide, prednisone, vincristine cyclophosphamide, doxorubicin 

ESMO also recommends consolidative mediastinal RT (doses in the range 30–36 Gy, in 1.5–2.0 Gy fractions) in patients treated with standard-dose chemoimmunotherapy but could be omitted in patients with a complete metabolic response only after DA-EPOCH-R. 

Autologous stem cell transplantation (HDCT/ASCT) is not recommended in patients who achieved complete remission even in initially poor-risk patients who attain an adequate response to initial therapy. [36]


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